Dr Alex Wodak is a man both admired and feared by government. That’s because of the huge influence he’s had over Australia’s drug policy and his refusal to be intimidated or silenced. His consistent message for almost 30 years has been: we’ve lost the war on drugs, prohibition doesn’t work. Ice hasn’t changed that.

1st lesson for new inquiry into ice: we've lost the war on drugs | Alex Wodak

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So as I face the new challenges of rising ice addiction in my work, I wanted to know how Wodak had reached this conclusion. Today, he says that he would prefer to live in a world where drug prohibition worked. But, he assures me, “We don’t live in such a universe. We live in a universe where you can’t eliminate drug use. Attempts to try and make drugs that are dangerous disappear usually makes a bad situation even worse and at great cost.”

Wodak’s thinking was crystalised over decades of working on the frontline. He and his colleagues at Sydney’s St Vincent’s hospital helped stem a significant HIV epidemic across Australia with a needle and syringe program; they were also the architects of the medically supervised injecting centre in Kings Cross, which has not had a fatal overdose in 14 years of operation.

It was working in Kings Cross in the 1980s, with the HIV epidemic in full swing, that Wodak first realised prohibition was a failure. At the time, Wodak’s colleagues and contemporaries Julian Gold, David Cooper and Ron Penny estimated from a survey that more than 3,000 gay men in the Taylor Square/Kings Cross neighbourhood had become infected with HIV over a 12 month period.

They were afraid that unless governments acted quickly, HIV would kill many people. He saw it as a national public health catastrophe starting in his patch and on his watch.

His thesis was a simple one: HIV was spreading because of unprotected sex and the re-use of needles and syringes by injecting drug users. The Netherlands and UK had begun clean needle programs and Wodak thought Australia should follow suit. He submitted over a dozen proposals requesting official permission to trial a pilot program. To his dismay, these were all declined. Civil disobedience was a last and desperate resort.

“There was a group of us, including Kate Dolan and Gino Vumbaca,” remembers Wodak:

We just put a sheet of paper on the door with a drawing pin in it saying, ‘If you want a free, clean needle and syringe, press the buzzer for Door A.’ People pressed the buzzer for Door A and someone would come.

We’d stolen a couple of milk crates, one of the milk crates had clean needles and syringes and the other had used needles and syringes. We also had a clipboard and a tally sheet, how many in, how many out, that sort of thing. It was all very simple. We paid for it all ourselves.

Wodak was called into the NSW health department and warned he’d be charged if he didn’t stop. He didn’t, but to Wodak’s astonishment, detectives told him that they had decided not to press charges. He realised that meant the NSW government would be forced to accept the needle exchange.

The policy that was designed to protect saw an increase in deaths from overdose by a staggering 55 times.

In 1987, the NSW government rewrote legislation to regulate the use of sterile needles and syringes for prohibited drugs. The Drug Misuse And Trafficking Act now made an “Exemption for authorised persons participating in approved needle exchange program[s]”.

It was the first needle exchange program established and approved in Australia. Within a couple of years, the whole country was covered. Australia was only the third country to do this.

After the battle was over, Wodak sat in his office wondering why he and his team had been forced to fight so hard for something that was going to save many lives and dollars. That’s when it occurred to him that “prohibition” was the true enemy. But he needed to understand more.

In 1987, he took sabbatical leave and travelled to Europe and North America to study their responses to HIV and drug use. Two encounters on this trip confirmed Wodak’s growing suspicion with drug prohibition policy.

The first was with a senior official in the US State Department in Washington DC. Wodak confessed to the deputy director of the bureau of international narcotic matters that he had begun doubting the “war on drugs” and asked for some evidence that drug prohibition worked. His host said:

[T]his year we’ve blown our budget and we’ve had to revise it. And in the revised budget for this financial year, every section of the US State Department had to cut its spending. Only two sections of the State Department were spared the cut: Embassy Security and us.

For a doctor obsessed with evidence, this wasn’t convincing. Wodak recalls:

That was the evidence that he gave me that drug prohibition worked. And so I realised that what he was really trying to tell me was that as far as he was concerned, it didn’t matter whether it worked in practice or not. It only mattered that it worked bureaucratically. That had a huge impact on me.

The second encounter happened in a dingy Brooklyn basement where he witnessed two men and two women injecting “speed balls” of cocaine mixed with heroin.

Wodak remembers the sheer horror of the scene:

These people were injecting drugs so recklessly, it was so grotesque, so hazardous. Blood was dripping from their arms. The room was only lit by a few candles. They were groping in the darkness with their hands trying to find a needle and syringe. They would then ask, “Is this yours or mine?”

These were perfect conditions for an HIV epidemic. This wasn’t a war on drugs so much as a war on people who used drugs, who were mainly people living in severe poverty. Wodak told me:

These were minority populations who almost certainly had a terrible education, lived in squalor, barely ate enough food to survive, had no money in the bank, no assets, no security, no quality of life, ditto for their children, ditto for the grandchildren, ditto for their great-grandchildren.

Behaving as they did made sense in that they had no future. To spend a few hours in a chemically-altered very blissful state made a lot of sense. That experience made me realise just how important the social factors are in drugs, it was really a turning point for me.

When he returned to Australia, he was a changed man. It wasn’t just the HIV epidemic that was killing people – it was the policy of prohibition that didn’t work, cost a fortune and harmed communities.

In 1964 there had been six heroin overdose deaths in Australia. By 1999, the peak year, heroin overdose deaths reached 1,116. The very policy that was designed to protect us had in fact seen an increase in deaths from overdose by a staggering 55 times (allowing for population increase) between 1964 and 1997.

My grandfather Ted Noffs knew the harm heroin was creating all too well. In 1964 Noffs founded a little church in the middle of Kings Cross called the Wayside Chapel that was, in reality, much more than a church. He once described the heroin issue as akin to “watching a horror movie in slow motion” between the 1950s and the 1980s.

Wodak met my grandfather in the 1980s to discuss the threat of HIV but it was Ray Richmond – the young rebel pastor who took over running the most heretical church in Australia from my grandfather – who approached Wodak about the number of people injecting and dying around the Chapel.

Wodak and Richmond came up with the idea that a medially supervised shooting gallery could help to reduce deaths and people shooting up in the streets. The then premier of NSW, Bob Carr, had just announced a Drug Summit. This provided the impetus to open the shooting gallery in the Wayside Chapel, despite not having the legal authority. Wodak and his contemporaries were – once again – resorting to civil disobedience in order to convince politicians to subscribe to life-saving drug policy.

On the day it opened, then-prime minister John Howard went on national TV to denounce it. Police ended up charging Richmond and three heroin users. TV crews filmed the scene. But the magistrate who heard the cases threw out all the charges.

The Drug Summit followed not long after in May 1999 and Carr announced he had been persuaded by the strength of the arguments that an injecting centre was a good idea. In July 1999 the Sisters of Charity (who own St. Vincent’s) were invited to run the centre. After the Vatican vetoed the sisters from doing so, it was taken over by the Uniting Church and officially opened in May 2001.

In the intervening years, a dozen independent reports have shown how valuable the centre is, how its benefits far outweigh the very few negatives there are. Lately, Wodak and I have been discussing the idea of an “ice room”, which would operate on similar principles to the injecting centre. But he reminds me of the battle we have ahead:

You have to keep on coming back to the fact that this field does not operate on a level playing field. We have to have 20 times the quantity of evidence, 20 times the quality of evidence before people will take us seriously. Even then we’ve still got a 200km/hr headwind blowing in our faces.

But things are starting to change. I don’t mind being subjected to scrutiny. I don’t mind being disbelieved. In the end, because we’re being treated so badly, we’ve lifted our game and got better and better at what we do.

It’s easy to see why people fear this man. It’s not that easy to dismiss him.